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Clare J Fowler - One of the best experts on this subject based on the ideXlab platform.
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Urinary Retention in women its causes and management
BJUI, 2006Co-Authors: Rajesh Kavia, Ranan Dasgupta, Soumendra N Datta, Sohier Elneil, Clare J FowlerAbstract:Urinary Retention in women is a diagnostic and therapeutic challenge to urologists and to all involved in the treatment of the condition. The patients referred to a single institution with this condition over a 4-year period were audited and the data are presented. The importance of Fowler's syndrome is described, as is the value of sacral nerve stimulation in this condition. In another paper, authors from France present evidence of occult dysautonomia in Fowler's syndrome. OBJECTIVE To report the experience of the last 4 years from a centre to which women with voiding difficulties and Urinary Retention were referred nationally, describing what investigations were helpful in making a diagnosis and the management strategies used PATIENTS AND METHODS Women with voiding difficulties and Urinary Retention remain a diagnostic and management challenge, and those with no anatomical or neurological basis for their symptoms may be dismissed, assuming that their Retention has a psychogenic basis. The finding of an electromyographic (EMG) abnormality of the striated urethral sphincter explaining their disorder (Fowler's syndrome) has led to the referral of women for consideration of that diagnosis. Thus we audited the referrals to the centre over a 4-year period of such women. RESULTS In all, 247 women (mean age 35 years) with complete (42%) or partial Retention (58%) were referred; 175 (71%) had urethral pressure profilometry, 141 (57%) had a transvaginal ultrasonographic measurement of the sphincter volume, and 95 (39%) had sphincter EMG. The mean maximum urethral closure pressure difference between patients with an EMG abnormality (101.5 cmH2O) and the patients with known other causes of voiding dysfunction (66.2 cmH2O) was 35.3 cmH2O (P < 0.05). In patients with complete Retention there was a significant difference in sphincter volume between those who were EMG-positive (2.14 mL) or EMG-negative (1.64 mL) (P < 0.05). CONCLUSION These investigations helped to classify the cause of Retention in two-thirds of cases. The commonest diagnosis was Fowler's syndrome, in which sacral nerve stimulation is the only intervention that restores voiding.
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changes in brain activity following sacral neuromodulation for Urinary Retention
The Journal of Urology, 2005Co-Authors: Ranan Dasgupta, Hugo D Critchley, Raymond J Dolan, Clare J FowlerAbstract:ABSTRACTPurpose: Sacral nerve stimulation (neuromodulation) can restore bladder sensation and the ability to void in women with Urinary Retention due to sphincter overactivity (Fowler’s syndrome). Modulation of central afferent activity is considered critical to this therapeutic effect but the neural mechanisms are poorly understood. Therefore, we undertook a functional brain imaging study to determine how neuromodulation acts on brain centers involved in the representation and control of bladder function.Materials and Methods: Eight patients with Fowler’s syndrome and 8 healthy controls underwent brain imaging with positron emission tomography to identify regions of brain activity relating to the perception of bladder fullness and their modulation by sacral nerve stimulation.Results: In healthy controls bladder fullness enhanced activity in brainstem (midbrain) and limbic cortical regions. Women with Urinary Retention showed no significant brainstem activity but did show enhanced limbic cortical activity...
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maximum urethral closure pressure and sphincter volume in women with Urinary Retention
The Journal of Urology, 2002Co-Authors: Oliver Wiseman, Michael J Swinn, Ciaran M Brady, Clare J FowlerAbstract:Purpose: In 1988 a syndrome of isolated Urinary Retention in young women that is associated with electromyographic abnormality of the striated urethral sphincter was described. It was hypothesised that Urinary Retention resulted from a failure of sphincter relaxation. The electromyographic abnormality causes overactivity of the muscle and may induce changes of work hypertrophy. If the hypothesis that the electromyographic abnormality is the cause of Urinary Retention is correct, we would expect the urethral sphincter to be enlarged and the urethral pressure profile to be increased in these women. We evaluated the role of static urethral pressure profilometry and transvaginal ultrasound in women in Urinary Retention.Materials and Methods: A total of 66 women in complete or partial Urinary Retention underwent electromyography of the striated urethral sphincter using a concentric needle electrode, followed by urethral pressure profile and/or urethral sphincter volume measurement by transvaginal ultrasound.Re...
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the cause and natural history of isolated Urinary Retention in young women
The Journal of Urology, 2002Co-Authors: Michael J Swinn, Oliver Wiseman, Eithne M Lowe, Clare J FowlerAbstract:Purpose: Using a questionnaire mailed to patients we evaluated the course and natural history of Urinary Retention in women, of which the cause is attributed to electromyography abnormality of the striated urethral sphincter. Previously Urinary Retention in young women has often been considered to be due to multiple sclerosis or a manifestation of a psychogenic disorder.Materials and Methods: A questionnaire was mailed to 216 women with abnormal sphincter electromyography and Urinary Retention. Of the 112 responses we analyzed the 91 from those who had been in complete Urinary Retention.Results: Mean patient age at the onset of complete Retention was 27.7 years (range 10 to 50). No patients had neurological features indicating a cauda equina lesion or central demyelination and none had progressed to features of a general neurological disorder. Mean maximum bladder capacity at the initial episode of complete Retention was 1,208 ml. Of the women 65% reported an event that had apparently precipitated Urinary...
Lorraine S Wallace - One of the best experts on this subject based on the ideXlab platform.
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sacral nerve stimulation for treatment of refractory Urinary Retention long term efficacy and durability
Urology, 2008Co-Authors: Wesley M White, Cindy Dobmeyerdittrich, Frederick A Klein, Lorraine S WallaceAbstract:Objectives To examine the long-term efficacy and durability of sacral nerve stimulation (SNS) for the treatment of refractory, nonobstructive Urinary Retention. Methods A retrospective study of all patients who underwent SNS with the InterStim device for refractory, nonobstructive Urinary Retention was performed. All patients had their history taken, underwent physical examination and urodynamic study, and completed a voiding diary before treatment with staged SNS. Patients with greater than 50% improvement in symptoms underwent implantable program device placement. Patients were followed up for evidence of postoperative complications, device failure, and treatment efficacy. Statistical analyses were performed. Results From June 1, 2000 to February 1, 2007, 40 patients were treated with SNS for refractory, nonobstructive Urinary Retention. Of the 40 patients, 29 had complete Urinary Retention (using clean intermittent catheterization), and 11 demonstrated incomplete Retention (elevated postvoid residual urine volume). Of the 40 patients, 28 (70%) demonstrated greater than 50% improvement in symptoms and underwent implantable program device placement. At a mean follow-up of 40.03 ± 19.61 months, 24 (85.7%) of 28 patients demonstrated sustained improvement of greater than 50%. Of the 28 patients, 4 (14.3%) had their InterStim device removed and 6 (21.4%) required revision. Among those with complete Retention, significant improvement occurred in the number of catheterizations/day and the volume/catheterization (P Conclusions At a mean follow-up of 40 months, 85.7% of patients with refractory, nonobstructive Urinary Retention demonstrated greater than 50% improvement in symptoms with SNS. For 911 patients, a statistically significant improvement in voiding parameters resulted.
Cindy L Amundsen - One of the best experts on this subject based on the ideXlab platform.
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sling revision removal for mesh erosion and Urinary Retention long term risk and predictors
American Journal of Obstetrics and Gynecology, 2013Co-Authors: Michele Jonsson Funk, Nazema Y Siddiqui, Virginia Pate, Cindy L AmundsenAbstract:Objective The objective of the study was to estimate the long-term risk of sling revision/removal after an initial sling and to assess indications (mesh erosion and Urinary Retention) and predictors of sling revision/removal. Study Design Using a population-based cohort of commercially insured individuals, we identified women 18 years old or older who underwent a sling (Current Procedural Terminology code 57288) between 2001 and 2010 and any subsequent sling revision/removal (Current Procedural Terminology code 57287). We estimated the cumulative risk of revision/removal annually and evaluated predictors of sling revision/removal using Kaplan-Meier survival curves and Cox proportional hazards models, respectively. Results We identified 188,454 eligible women who underwent an index sling. The 9 year cumulative risk of sling revision/removal was 3.7% (95% confidence interval [CI], 3.5–3.9). At 1 year, this risk was already 2.2% and then increased to 3.2% at 4 years before plateauing. With regard to the indication for the sling revision/removal, a greater proportion was due to mesh erosion compared with Urinary Retention, with a 9 year risk of 2.5% (95% CI, 2.3–2.6) for mesh erosion vs 1.3% (95% CI, 1.2–1.4) for Urinary Retention. Age had an effect on the revision/removal rates for both mesh erosion and Urinary Retention, with the higher risks among those aged 18-29 years. The risk of revision/removal for mesh erosion and Urinary Retention was also elevated among women who had a concomitant anterior or apical prolapse procedure. Conclusion In this population-based analysis, the 9 year risk of sling revision/removal was relatively low at 3.7%, with 60% of revisions/removals caused by mesh erosion.
J P Roovers - One of the best experts on this subject based on the ideXlab platform.
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predicting short term Urinary Retention after vaginal prolapse surgery
Neurourology and Urodynamics, 2009Co-Authors: R A Hakvoort, Marcel G W Dijkgraaf, M P M Burger, M H Emanuel, J P RooversAbstract:Aims Identification of risk factors for Urinary Retention after vaginal prolapse surgery. Methods The medical records of 345 women undergoing surgical correction for symptomatic pelvic organ prolapse were analyzed. Independent risk factors for the development of post-operative Urinary Retention were identified by performing univariate and multivariate logistic regression analysis. Variables included in the analysis were age, parity, body mass index, previous prolapse surgery, previous hysterectomy, menopausal status, degree of prolapse, type of anesthesia, type and technique of surgery, operation time, intra-operative blood loss, preoperative Urinary stress-incontinence, and other co-morbidities. Main outcome measure was the occurrence of Urinary Retention defined as a residual volume after voiding higher than 200 ml as measured by bladder scan. Results High grade cystocele (OR 2.5, CI 1.3–4.7), performing levator plication (OR 4.3, CI 2.0–9.3), performing Kelly plication (OR 5.1, CI 1.7–15.5) and amount of intra-operative blood loss (OR 1.4 per 100 ml, CI 1.1–1.8) were identified as independent risk factors for the occurrence of Urinary Retention after vaginal prolapse surgery. Conclusions Urinary Retention after vaginal prolapse surgery occurs more frequently in women with larger cystoceles, severe intra-operative blood loss and the application of levator plication and Kelly plication. Neurourol. Urodynam. 28:225–228, 2009. © 2008 Wiley-Liss, Inc.
Michael J Swinn - One of the best experts on this subject based on the ideXlab platform.
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maximum urethral closure pressure and sphincter volume in women with Urinary Retention
The Journal of Urology, 2002Co-Authors: Oliver Wiseman, Michael J Swinn, Ciaran M Brady, Clare J FowlerAbstract:Purpose: In 1988 a syndrome of isolated Urinary Retention in young women that is associated with electromyographic abnormality of the striated urethral sphincter was described. It was hypothesised that Urinary Retention resulted from a failure of sphincter relaxation. The electromyographic abnormality causes overactivity of the muscle and may induce changes of work hypertrophy. If the hypothesis that the electromyographic abnormality is the cause of Urinary Retention is correct, we would expect the urethral sphincter to be enlarged and the urethral pressure profile to be increased in these women. We evaluated the role of static urethral pressure profilometry and transvaginal ultrasound in women in Urinary Retention.Materials and Methods: A total of 66 women in complete or partial Urinary Retention underwent electromyography of the striated urethral sphincter using a concentric needle electrode, followed by urethral pressure profile and/or urethral sphincter volume measurement by transvaginal ultrasound.Re...
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the cause and natural history of isolated Urinary Retention in young women
The Journal of Urology, 2002Co-Authors: Michael J Swinn, Oliver Wiseman, Eithne M Lowe, Clare J FowlerAbstract:Purpose: Using a questionnaire mailed to patients we evaluated the course and natural history of Urinary Retention in women, of which the cause is attributed to electromyography abnormality of the striated urethral sphincter. Previously Urinary Retention in young women has often been considered to be due to multiple sclerosis or a manifestation of a psychogenic disorder.Materials and Methods: A questionnaire was mailed to 216 women with abnormal sphincter electromyography and Urinary Retention. Of the 112 responses we analyzed the 91 from those who had been in complete Urinary Retention.Results: Mean patient age at the onset of complete Retention was 27.7 years (range 10 to 50). No patients had neurological features indicating a cauda equina lesion or central demyelination and none had progressed to features of a general neurological disorder. Mean maximum bladder capacity at the initial episode of complete Retention was 1,208 ml. Of the women 65% reported an event that had apparently precipitated Urinary...